Clinical and morphological aspects of myocardial damage and cardioprotection in patients with leukemia
Myocardial damage in the background of leukemia is considered as a manifestation of the disease and various types of therapy. It is noted that myocardial damage in this category of patients is the result of multifactorial effects on the myocardium in the oncohematologic patient. The problem of cardioprotection is quite actively studied in order to develop effective prophylaxis and reduce the cardiotoxicity of the most common groups of cytostatic drugs. Purpose — to investigate the features of myocardial damage in patients with leukemia and the prospects of therapeutic intervention. A comprehensive clinical and laboratory study was conducted for 92 patients with leukemia who were on examination and treatment in the hematological department of the Vinnitsa Regional Clinical Hospital named after M.I. Pirogov and received cytostatic therapy in accordance with the nosology and protocol of medical care of the Ministry of Health of Ukraine. Additionally, patients were screened for quality of life indicators according to the methods proposed by us. The statistical processing of the obtained results was carried out in the license package “STATISTICA 6.1” with the use of nonparametric methods for evaluating the obtained results. Evaluated the correctness of the distribution of characteristics for each of the variation series received, the mean of each studied feature, and the standard quadratic deviation. The reliability of the difference between independent quantitative values was determined using the Man-Whitney U-criterion. Signs of myocardial damage were detected in all patients prior to cytostatic therapy. The analysis of medical correction of myocardial damage in patients is carried out. All patients received metabolic therapy in the form of Meldonium, Arginine, Tivortin and aspartic acid. However, these appointments were not standardized, which did not allow to assess the effectiveness of their appointment. Therapy for heart failure was performed by metabolic, diuretic, accompanied by clinical and laboratory improvement. Prospects of standardization of pharmacological cardioprotection in patients with leukemia are considered.
2. Nakaz MOZ Ukrayiny vid 30.06.2010 № 647 “Pro zatverdzhennya klinichnykh protokoliv nadannya medychnoyi dopomohy khvorym zi spetsial nosti “Hematolohiya” [. Order of the Ministry of Health of Ukraine dated June 30, 2010 No. 647 “On Approval of Clinical Protocols for the Provision of Medical Aid to Patients Specializing in Hematology”]. http://moz.gov.ua/ua/portal/dn_20100730_647.html.
3. Abdel-Qadir, H., Amir, E. & Thavendiranathan, P. (2016). Prevention, detection, and management of chemotherapy- related cardiac dysfunction. Canadian Journal of Cardiology, 32 (7), 891–899. https://doi.org/10.1016/j.cjca.2016.01.028.
4. Assuncao, B. M. B. L., Handschumacher, M. D., Brunner, A. M., Yucel, E., Bartko, P. E., Cheng, K. H. ... & Scherrer-Crosbie, M. (2017). Acute leukemia is associated with cardiac alterations before chemotherapy. Journal of the American Society of Echocardiography, 30 (11), 1111–1118. Doi: 10.1016/j.echo.2017.07.016.
5. Blaes, A. H., Thavendiranathan, P. & Moslehi, J. (2018). Cardiac Toxicities in the Era of Precision Medicine: Underlying Risk Factors, Targeted Therapies, and Cardiac Biomarkers. American Society of Clinical Oncology Educational Book, 38, 764–774. DOI: 10.1200/EDBK_208509.
6. Christenson, E. S., James, T., Agrawal, V. & Park, B. H. (2015). Use of biomarkers for the assessment of chemotherapy-induced cardiac toxicity. Clinical Biochemistry, 48 (0), 223–235. http://doi.org/10.1016/j.clinbiochem.2014.10.013.
7. Diwadkar, S., Patel, A. A. & Fradley, M. G. (2016). Bortezomib-Induced Complete Heart Block and Myocardial Scar: The Potential Role of Cardiac Biomarkers in Monitoring Cardiotoxicity. Case reports in cardiology, 2016, 3456287–3456287. doi:10.1155/2016/3456287.
8. Lipshultz, S. E., Landy, D. C., Lopez-Mitnik, G., Lipsitz, S. R., Hinkle, A. S., Constine, L. S. … Miller, T. L. (2012). Cardiovascular Status of Childhood Cancer Survivors Exposed and Unexposed to Cardiotoxic Therapy. Journal of Clinical Oncology, 30(10), 1050–1057. http://doi.org/10.1200/JCO.2010.33.7907.
9. López-Fernández, T., García, A. M., Beltrán, A. S., Luis, Á. M., Sanz, R. G., Ramos, P. M. ... & de Isla, L. P. (2017). Cardio-onco-hematology in clinical practice. Position paper and recommendations. Revista Española de Cardiología (English Edition), 70 (6), 474–486. https://doi.org/10.1016/j.rec.2016.12.041.
10. Piper, S. & Mcdonagh, T. (2015). Heart failure and hemotherapeutic agents. Future cardiology, 11 (4), 453–470. Doi: 10.2217/fca.15.28.
11. Raj, S., Franco, V. I. & Lipshultz, S. E. (2014). Anthracycline-induced cardiotoxicity: a review of pathophysiology, diagnosis, and treatment. Current treatment options in cardiovascular medicine, 16 (6), 315. https://doi.org/10.1007/s11936-014-0315-4.
12. Salvatici, M., Cardinale, D., Colombo, A. & Sandri, M. T. (2015). Cancer cardiotoxicity and cardiac biomarkers. Biomarkers in Cancer, 73–105. https://doi.org/10.1007/978-94-007-7681-4_20.
13. Salvatici, M. & Sandri, M. T. (2015). Identifying cancer patients at risk for cardiotoxicity. Future Oncology, 11 (14), 2077–2091. https://doi.org/10.2217/fon.15.69.
14. Salvatorelli, E., Menna, P. & Minotti, G. (2015). Managing anthracycline-induced cardiotoxicity: beginning with the end in mind. Future cardiology, 11 (4), 363–366. https://doi.org/10.2217/FCA.15.35.
15. Storozynsky, E. (2015). Multimodality assessment and treatment of chemotherapy-induced cardiotoxicity. Future cardiology, 11 (4), 421–424. https://doi.org/10.2217/FCA.15.49.
16. Swiger, K. J., Singh, J. & Lenihan, D. J. (2017). Cardiomyopathic toxicity from chemotherapy: is there an opportunity for preemptive intervention? Current treatment options in cardiovascular medicine, 19 (3), 20. https://doi.org/10.1007/s11936-017-0517-7.
17. Wickramasinghe, C. D., Nguyen, K. L., Watson, K. E., Vorobiof, G. & Yang, E. H. (2016). Concepts in cardio-oncology: definitions, mechanisms, diagnosis and treatment strategies of cancer therapy-induced cardiotoxicity. Future Oncology, 12 (6), 855–870. https://doi.org/10.2217/fon.15.349.
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